Case Study
Improving the Efficiency and Quality of Primary Source Verification
This Health Plan is one nation’s first and largest specialty networks for comprehensive pain management, post-acute care and addiction recovery within the workers’ compensation industry. Their network includes more than 55,000 healthcare providers at locations across the country. Working with so many providers, the organization needed more accurate and timely primary source verification (PSV) to accelerate the credentialing process.
The Challenge
This Plan was concerned that key data elements were being overlooked, and the omission would severely impact their ability to fully evaluate provider applications, while increasing their susceptibility to audit risks.
To meet a projected increase in credentialing providers and improve the quality of its data, the Plan would need to hire two new associates. Because the cost of onboarding new personnel and building a fully automated PSV solution was impractical, the Plan decided to outsource their data verification needs.
The plan chose CAQH as their Primary Source Verification CVO since their experience working with CAQH for Credentialing had been a positive one. CAQH provided highly trained staff and technology automation to help manage larger file volumes while increasing the quality of the data.
The Solution
A More Accurate and Efficient PSV Process
Automated staff workflow
The Plan’s team was spending at least 20 minutes per provider file manually importing data and additional time calling providers for missing data. CAQH PSV uses a combination of automated processes and a specially trained team to collect, import, validate and confirm provider data and finalize files.
Reduced audit vulnerability
As an NCQA-Certified Credentials Verification Organization (CVO), CAQH meets all regulatory requirements for verified data elements, reducing the plan’s audit vulnerability.
No data pass-through fees
CAQH bundles data extract fees and licensing databases as a flat-rate cost. This helped the Plan avoid overlapping service and data charges.
The Results
Since deploying CAQH Primary Source Verification, the Plan has achieved a time savings of at least 20 minutes per provider file dues to automated processes and a direct connection to primary source data. CAQH also uses a multi-step validation process that follows NCQA guidelines giving the Plan confidence that its network is providing safe care for its members.
A 20-minute time savings per provider file
Optimized staff time with an automated workflow
Faster collection of primary source reports
Reduced audit vulnerability
Scalable services and staffing to enable growth
Eliminated pass-through fees for data collection
Driving change with technology
CAQH solutions automate workflows, deliver a wealth of accurate and actionable data, and create a better experience for both providers and health plans.
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